Quality Indicator Resources

The resources below broadly apply to the Quality Indicator modules and provide valuable background information on their development. They provide information about the life cycle of the AHRQ QIs and related topics, including the methodology used in the software to calculate the QIs. Resources are also available on AHRQ’s process to convert the QIs from ICD-9-CM to ICD-10-CM/PCS.

Quality Indicator Development

The AHRQ QI measure development process involves four phases. The first phase is candidate indicator development for an identified topic area of interest. This phase has several steps involved in it. Ranging from identification of candidate indicators, and literature reviews to finalization of specifications, and summary of evidence for each recommended candidate indicator. The second phase is implementation of the QIs into the AHRQ QI software, which involves coding the QIs into the software, testing, and developing user documentation. The third phase is maintenance of the QIs, which involves review of the evidence, technical specification updates, periodic clinical panel review, NQF endorsement submission and maintenance, and newly available data and methodological advances. The final phase is retirement which involves evidence, removing coding from software, testing and user documentation.

These phases and processes sometimes may require modifications to meet the needs of indicator development in new areas.The quick summary report of QI Development and full report can be found below.

Quality Indicator Methodology Tools

  • Improving the AHRQ Quality Indicators, December 2014 —New! Summary of findings and recommendations for improving the methodological approach of the AHRQ Quality Indicators.

  • Persons using assistive technology may not be able to fully access information in this document. For assistance contact the Quality Indicators support at (301) 427-1949 or by email at: QIsupport@ahrq.hhs.gov

  • AHRQ Quality Indicator Empirical Methods, Revised December 2014 — Describes the empirical methods used to calculate the AHRQ QI, including creating the analysis data; flagging discharges for inclusion and exclusion based on the indicator numerator and denominator specifications; calculating observed, expected, risk-adjusted, and smoothed rates and confidence and probability intervals; and calculating composite values, weights, and probability intervals.


  • AHRQ ICD-10-CM/PCS Conversion Project, Nov 2013 — Documents the process and status of converting AHRQ QIs from ICD-9-CM to ICD-10-CM/PCS.

  • ICD-9-CM to ICD-10-CM/PCS Conversion of AHRQ Quality Indicators, March 2011 — Provides background information on the transition from ICD-9-CM to ICD-10-CM and ICD-10-PCS for HIPAA transactions

  • AHRQ RAHM Workgroup Technical Report — Provides an overview of the structure of the administrative data from the Nationwide Inpatient Sample and the statistical models and tools currently used within the AHRQ QI Project; also proposes alternative statistical models and methods for consideration

  • Calculating Standard Errors and Confidence Intervals for the AHRQ Quality Indicators

  • The Markov Chain Monte Carlo Integration Approximation in the AHRQ QI Prediction Module Closely Matches Exact Integration Results (Posted: 2/19/2014)  — Summarizes testing to determine whether a Prediction Model (PM), used to predict functions of the AHRQ QI while accounting for missing covariates, was implemented properly and whether the expected values calculated by the PM are close approximations of the exact values obtained using direct integration.
  • QI for Home and Community Based Services (HCBS)

    The quality indicators (QIs) reflect the health and well-being of beneficiaries receiving home and community-based services (HCBS) through state Medicaid programs. The indicators focus on the well-being of HCBS beneficiaries as reflected by potentially preventable hospitalizations. These include hospitalizations for specific conditions associated with chronic disease exacerbation and progression as well as poor access to care and support services. The HCBS Population Technical Report provides background on the HCBS QI development as well as the results of the HCBS literature review, discussions with HCBS population experts, and empirical analyses. For additional information on the development of the HCBS QIs, view the resources below:

    • Literature Review — Provides guidance for using the AHRQ QI for public reporting and payment initiatives; includes analysis of each indicator to determine their appropriateness for use in comparative reporting and comparative reporting templates based on input from consumers, providers, experts in the field of public reporting, and others.

    • Expert Panels — Summarizes HCBS panel comments on the validity of the HCBS indictors as a set, factors that panelists believe might impact hospitalizations for the indicator conditions or events in the HCBS populations and panelists’ comments and concerns about each indicator.

    QI Reporting / Tips for Users

    National Quality Forum

    The National Quality Forum (NQF) is an independent, voluntary, consensus-based member organization that endorses standardized quality measures. Below is a list of the AHRQ QIs that are endorsed by the NQF.